Coughing up blood with rapid weight loss

LBM 6 M. 11

Step 1

Miosis and ptosis (horner’s syndrome)

Miosis  Small pupil ; ptosis  palpebra can’t open as a normaly

Facial anhidrosis 

Step 2

1. Why the man feels shortness breath and pain in lower chest?
2. Why the man cough with phlegm and sometimes with hoarse voice?
3. Why the man cough up blood?
4. Why the appetite to be wight loss?
5. Why when the physical examination founded with facial anhidrosis, miosis and ptosis?
6. What is the differential diagnose from the scenario?
7. Why when he run out to the medicine, he suffered from cough and shortness again?
8. What is the the treatment from the scenario?
9. What is the ethiology and phatogenesis the diagnose?
10. What is clinical manifestation?
11. What is risk factor?
12. What is classification of diagnose?

Step 3

1. Why the man feels shortness breath and pain in lower chest?
Answer :
Pain : Because of abnormality from the cell in the lung hyperplasia and metaplasia caused by
expose of cigarrete or polutan result in onset mass or tumor in the lung tumor infection the wall
chest  pressing chest wall  cause damage  destruction  cause pain chest wall
Shortness breath : hyperlasia cell in bronkus can obstruck broncus  oxigen in lung can’t exit in
normaly
Restrictif cause decrease the complain of lung
2. Why the man cough with phlegm and sometimes with hoarse voice?
Answer :
expose of cigarrete or polutan result iritasin  pain  in n. Laryngeus reccurens  hoarse
voice
there are mass  press the n. Laryngesus reccurens  hoarse voice
3. Why the man cough up blood?
Answer :
Hyperplasia  press the vascular  ruptur of the vascular  hemorrhage in the lung  cough
up blood
4. Why the man lossing appetite which cause weight loss?
Answer :
 The nutrition for the body eat for the mass, so the body wight loss
Lectin hormone that rule the appetite.
5. Why when the physical examination founded with facial anhidrosis, miosis and ptosis?
Answer :
6. What is the differential diagnose from the scenario?
Answer :
Lung neoplasm : opaque mass (in other diagnose)
TBC
brochiectasis
7. Why when he run out to the medicine, he suffered from cough and shortness again?
Answer :
The treatment just for the symptoms
8. What is the ethiology and phatogenesis the diagnose?
Answer :
ethiology
 Polutan
 Cigarrete
 Expose from chemical compound, ex : asbes
 Genetic factor occur the deletion in crhomosom P53
 Reinflamation

Phatogenesis

When we respiration contain polutan, chemical  lung expose in cronic time  inhalation
respiration  iritation lung  carcinogenic cell  there are 3 level

1. pre-carcinoma

The cell to be big and loss the cilia  function cell goblet and seromucus become
hypersecretion

2. Ca in situ

3. invasisve carsinoma

9. What is classification of diagnose?

Answer :
 Small cell lung cancer (SCLC)  domain from smal cells than contain mucus with little
cromatin
 Non – SCLS  adenocarcinoma squamos cell
10. What is clinical manifestation?
Answer :
Different in

Anamnesis :

 Hemoptoe
 Anoreksia
  Fever
 Malaise
 Tired
 Muscle wikness
 Decrease of weight

physical examination :

 Miosis and ptosis

 Sterm fremitus low
 Perkusi : pekak
 Facial anhidrosis

diagnostic examination
foto rontgen : opaque mass

11. What is risk factor?

Answer :
 Smoking
 Polution
 Job with expose chemical

12. What is the the treatment from the scenario?

Answer :
Supportif treathment
 Vitamin and mineral
 Medicine for increase the appetite

Symptomatic treathment

 For the pain, shortness breath given paliative radiation

 For carcinoma the last stadium given reduce the pain, ex : morfin inj., petidine

For carcinoma

 Surgery
 Radiotherapy
 Cemotherapy
 Combination

Other treathment

 Imunotherapy and psycotherapy

Step 4
Ethiology  phatophysiology (short explain)  clinical manifestation fever, hemoptisis, horner’s
syndrome  physical examination  diagnostic examination  lung neoplasm  treathment